Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, June 25, 2008

This a CT scan of a really cool problem we've probably all heard of but never seen. For the sake of argument let's call our patient "Carl Peel"- Dr. Peel's illegitimate son by Bill Clinton. He came in just a few days ago. I'll give everybody some time to guess the diagnosis before giving the whole story. What is wrong with Carl?

Could be Gallstone Pancreatitis, or a Splenic Artery Thrombosis, Idiopathic Pneumobilia, Pneumoperitoneum, or a case of Kuru. Dammit this is stealing the Thunder from my "Why I hate Radiologists" post.

Poor carl has thrombosis of his portal system, or possibly just his superior mesenteric vein. I bet he presented with diffuse abd. pain, non localized at first. Had to have a portion of his bowel resected, but is doing ok now, no? Carl was found at workup to have protein C deficiency.

ok, here's a stretch:-"Carl" is a subtle reference to Caddyshack.-Carl Spackler was given the option of swimming in a "pool or the pond", with preference being given to the pond-Carl swam in the pond-Carl got a liver fluke (eg clonorchis)-Carl got cholangiocarcinoma-Carl died.-Fuck all'y'all

Looks like the poor chap's got some kind of obstruction in his portal circulation...don't know if it's related to parasites, or alcohol, or some sort of funky hepatitis or what. Just a wild guess. In any case, it looks like he's in deep trouble!

Cat and Anon are probably close. This looks like a broken Greenfield filter with perforation of the inferior vena cava and retroperitoneal hemorrhage as the likely cause of the inflammatory changes inferior to the IVC and/or portal vein..Suspect he was in serious pain.I've never seen it happen but supposedly is a complication of placement of the IVC. And maybe he did have a clotting disorder, antithrombin deficiency etc as the reason for placement secondary to recurrent PE's..??Correct??

I hereby decree that, now and henceforth forever, these radiological findings shall be referred to by all educated healthcare professionals as "abdominal jellyfish sign," which shall be pathoneumonic for "oh shit, the greenfield broke and Carl is bleeding to death! Get the general surgeon! Oh shit, oh shit, oh shit!"